Introduction In our experience, surgical participation in point-of-care simulation training has been poor, in most part due to the lack of an available surgical simulator. Our aim was to create an interactive operative site within a simulation manikin, to encourage surgical participation in point-of-care simulation team training.
Method Using a non-functional Laerdal SimMan manikin, we removed the abdominal block (usually houses the bowel sounds speaker) and created a mould of this cavity using plaster of Paris. This mould was painted, and then made waterproof using several layers of PVA glue. A Sengstaken tube was secured in the centre of the cavity to replicate a large blood vessel (the four lumens allowing us to create multi-source bleeding), and moulding clay was used to replicate the liver/Bowel. A section of synthetic skin was secured tightly across the top of the cavity, with enough tension to allow surgical incisions to be performed. The manikin with the new abdominal insert was then used for a point-of-care surgical scenario covering the management of intra-operative haemorrhage.
Results The simulation took place in surgical theatres involving a full theatre team, including a consultant and registrar from both surgery and anaesthesia, and anaesthetic and scrub ODPs. The scenario involved elective laparoscopic surgery complicated by intra-abdominal bleeding, with the learning points around the surgical decision making, the anaesthetic and surgical management of major haemorrhage, and the associated human factors. Feedback from the scenario was extremely positive, with particular reference to the surgical insert enhancing the surgical aspects of the simulation.
Conclusion The creation of our surgical insert was simple and inexpensive, and has allowed us to enhance the simulation experience for theatre team training. The insert is easily reproducible and reusable, and will allow incorporation of simple laparoscopic and open surgical procedures within point-of-care simulation.
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